Although national committees have recommended influenza vaccination for health care workers (HCWs) for years, rates are low nationally. Influenza disease causes suffering in HCWs, can kill sick patients, and can lead to absenteeism that makes staffing hospitals difficult. Vaccination of HCWs would be especially important in a pandemic. The investigators propose to increase influenza vaccination rates of HCWs at University of Pittsburgh Medical Center (UPMC) health system through multi-modal interventions including (1) trial of a mass vaccination clinic (with food as incentives) to simulate what would be needed in a pandemic or bioterrorism attack; and (2) peer vaccination with vaccine vials distributed to nursing units for 24/7 access. Free vaccine will be offered and culturally competent publicity and education will be conducted. After discussions with hospitals in the system, eight hospitals have shown interest in the mass vaccination clinics; the remaining hospitals will act as concurrent controls that implement their usual employee vaccination proceedures. Intervention hospitals include the 1094 bed Presbyterian tertiary care center, specialty hospitals (Childrens at 260 beds and Magee Womens at 200 beds) and community hospitals (suburban Passavant at 324 beds, rural Bedford at 59 beds). UPMC is one of the largest health systems in the country with 40,000 employees. The theoretical framework is PRECEDE-PROCEED and the model is diffusion theory. Influenza vaccinations will be recorded electronically in Employee Health. By comparing influenza vaccination rates with historical and concurrent controls in bivariate and regression analyses, we will determine impact. To determine barriers, predictors of HCW vaccination, and attitudes, a web-based survey will be conducted, based on the Theory of Reasoned Action. Over-sampling of HCWs of color is planned. Hierarchical linear modeling and SUDAAN will be used to account for the clustering of HCWs in hospitals. To determine the costs of the mass vaccination clinic, fixed costs such as publicity and variable costs such as food incentives and employee time to attend the clinic will be calculated and compared to the costs of vaccination in a typical Employee Health clinic. The time that employees spend in each setting to obtain vaccination will be directly measured to better determine real costs. The multi-disciplinary team includes leading health services researchers with strong ties to public health policy and medical education and a strong publication record. Also, the team includes insiders with access to the data and processes within one of the largest and diverse health systems in the country. Senior management is firmly committed to the project to increase vaccination rates of HCWs. [unreadable] [unreadable]